Managed Health Care in the New Millennium : Innovative Financial Modeling for the 21st Century

Thoroughly exploring how capitation has evolved domestically and internationally in recent years, this book discusses actuarial assumptions and the difficulties in payers’ transitions from community-based underwriting to experience-based ratings. It explores what the future holds in the areas of clinical pathways and population-based risk assumption tools and approaches. It covers what happens when the underlying actuarial and risk assumptions are ignored or trivialized. The author also discusses the challenges capitation-based pricing faces from an international perspective, including Latin America and the Caribbean.

David Samuels, a leading authority on financial models in healthcare, draws on his multidisciplinary background in all aspects of managed care to provide an expansive yet detailed perspective of this complex field. Grounded in evidence-based modeling, the book’s multidisciplinary focus puts the spotlight on core concepts from the standpoints of health plans, hospitals, physician practice, and their respective integrated network models.

You’ll learn what happened when a country’s national health care plan is developed with problematic underwriting, why hospitals will always be victimized at their payer’s bargaining table, and even how to improve the current primary care shortage at both 50% less provider costs as well as with triple their members’ compliance in wellness care. The book gives you the critical tools to stay ahead of the learning curve, engage patients to take responsibility for their own and their family’s health status, and improve your differentiation in a RAPIDLY changing marketplace.